Correlates and outcomes of preterm birth, low birth weight, and small for gestational age in HIV-exposed uninfected infants

• Published in: BMC pregnancy and childbirth Vol. 14; no. 1; p. 7
• Main Authors: Slyker, Jennifer A, Patterson, Janna, Ambler, Gwen, Richardson, Barbra A, Maleche-Obimbo, Elizabeth, Bosire, Rose, Mbori-Ngacha, Dorothy, Farquhar, Carey, John-Stewart, Grace
• Format: Journal Article
• Language: English
• Published: England BioMed Central 08.01.2014
• Subjects: Adult; Babies; Birth Weight; Body Mass Index; Cervix Uteri - chemistry; Cervix Uteri - cytology; Female; HIV Infections - blood; HIV Infections - epidemiology; HIV Infections - virology; HIV-1; Humans; Infant; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Medical research; Neutrophils; Parity; Pregnancy; Pregnancy Complications, Infectious - blood; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - virology; Premature Birth - epidemiology; Retrospective Studies; Risk Factors; RNA, Viral - analysis; RNA, Viral - blood; Studies; Vaginal Discharge - epidemiology; Vaginosis, Bacterial - epidemiology; Womens health; Young Adult
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/1471-2393-14-7

Preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) contribute to neonatal mortality. Maternal HIV-1 infection has been associated with an increased risk of PTB, but mechanisms underlying this association are undefined. We describe correlates and outcomes of PTB, LBW, and SGA in HIV-exposed uninfected infants. This was a retrospective analysis of cohort study. Between 1999-2002, pregnant, HIV-infected women were enrolled into an HIV-1 transmission study. Logistic regression was used to identify correlates of PTB, LBW and SGA in HIV-negative, spontaneous singleton deliveries. Associations between birth outcomes and mortality were measured using survival analyses. In multivariable models, maternal plasma (OR = 2.1, 95% CI = 1.1-3.8) and cervical HIV-1 RNA levels (OR = 1.6, 95% CI = 1.1-2.4), and CD4 < 15% (OR = 2.4, 95% CI = 1.0-5.6) were associated with increased odds of PTB. Abnormal vaginal discharge and cervical polymorphonuclear leukocytes were also associated with PTB. Cervical HIV-1 RNA level (OR = 2.4, 95% CI = 1.5-6.7) was associated with an increased odds of LBW, while increasing parity (OR = 0.46, 95% CI = 0.24-0.88) was associated with reduced odds. Higher maternal body mass index (OR = 0.75, 95% CI = 0.61-0.92) was associated with a reduced odds of SGA, while bacterial vaginosis was associated with >3-fold increased odds (OR = 3.2, 95% CI = 1.4-7.4). PTB, LBW, and SGA were each associated with a >6-fold increased risk of neonatal death, and a >2-fold increased rate of infant mortality within the first year. Maternal plasma and cervical HIV-1 RNA load, and genital infections may be important risk factors for PTB in HIV-exposed uninfected infants. PTB, LBW, and SGA are associated with increased neonatal and infant mortality in HIV-exposed uninfected infants.